This is the fourth of a five-part series that covers best practices driving effective hand hygiene compliance. This blog discusses the importance of hand hygiene education.
Healthcare professionals who practice hand hygiene compliance are leaders in the fight against dangerous and sometimes deadly healthcare-associated infections (HAIs). This blog covers the why, when and how of hand hygiene education, training and coaching. It addresses several of the factors that can impact hand hygiene compliance.
The far-reaching impact of HAIs .
According to the World Health Organization (WHO), the overall prevalence of HAIs in developed countries varies between 3.5% and 12% and approximately the same proportion of hospitalized patients acquire at least one HAI. "Infections prolong hospital stays, create long-term disability, increase resistance to antimicrobials, represent a massive additional financial burden for health systems, generate high costs for patients and their family, and cause unnecessary deaths"1. Although HAIs occur throughout continuum of care, the majority of hospital-acquired infections relate to urinary tract, surgical site and blood stream infections and pneumonia.
Embracing the most recent guidance
Proper hand hygiene is the most important and effective method of preventing HAIs. CDC guidelines and WHO guidelines identify hand hygiene best practices and provide guidance on how healthcare facilities can improve performance.
Many healthcare facilities train the staff to clean their hands as they enter and exit patient rooms (Moments 1 and 4 of the WHO 5 Moments for Hand Hygiene). Many healthcare organizations use direct observations from outside the patient room door to measure healthcare worker hand hygiene compliance. But studies have shown that “in and out” misses about 50 percent of total hand hygiene opportunities.2 To make meaningful progress toward improving hand hygiene performance and reducing HAIs, some healthcare facilities are now moving away from using direct observations as the gold standard for tracking and measuring compliance and are instead moving toward electronic, automated monitoring technologies. Any system that empowers healthcare professionals to measure and monitor performance according to the CDC guideline or WHO 5 Moments, or the adapted version by the Canadian Patient Safety Institute (CPSI) of Your 4 Moments for Hand Hygiene (which are all generally aligned) is a tool for measuring total hand hygiene practices, rather than just what can be seen from the door.
Wash vs. Sanitize
Healthcare organizations and their clinical staff also need to understand when to wash hands with soap and water and when to sanitize hands. It’s best to use soap and water when hands are visibly dirty or visibly soiled with blood or other body fluids, or in the presence of certain microbial threats, such as Clostridium difficile. Use an alcohol-based sanitizer as the preferred means for routine hand antisepsis in all other clinical situations. If alcohol-based sanitizer is not obtainable, wash hands with soap and water (2009 WHO Guidelines on Hand Hygiene in Health Care).
It’s Not Just When You Do It, It’s How You Do It
The how of hand hygiene is as important as your choice of hand hygiene products. CDC and WHO provide handy, informative educational materials on proper hand-washing and using a handrub. According to the WHO best practice, it is important to use enough hand sanitizer to fully cover hands and maintain a 20-30 second wet time. In the course of learning the right process for sanitizing hands, see the WHO’s online resource on hand hygiene education and training and the CDC’s hand hygiene resource page.
Additional available resources
DebMed, as your partner in hand hygiene performance, supports efforts to improve hand hygiene performance with a wide range of resources including best practice tools, featuring "Deborah,' your virtual nurse educator and partner in compliance.
Our final blog in this five-part series will address the importance of accurate monitoring and feedback and how these tools may be used to improve hand hygiene compliance.
1 Health care-associated infections fact sheet, World Health Organization, http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
1 Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 Benchmark Study, Steed et al, Am J Infect Control. 2011 Feb;39(1):19-26. doi: 10.1016/j.ajic.2010.10.007.